LAWRENCE COUNTY MEMORIAL HOSPITAL Lawrenceville, Illinois. NOTICE OF PRIVACY PRACTICES Effective April 14, 2003 Revised May, 2013

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "LAWRENCE COUNTY MEMORIAL HOSPITAL Lawrenceville, Illinois. NOTICE OF PRIVACY PRACTICES Effective April 14, 2003 Revised May, 2013"

Transcription

1 LAWRENCE COUNTY MEMORIAL HOSPITAL Lawrenceville, Illinois NOTICE OF PRIVACY PRACTICES Effective April 14, 2003 Revised May, 2013 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU WILL BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY. We are Required By Law To: Our Duties Maintain the privacy of your health information. Give you this notice of our legal duties and privacy practices with respect to health information about you. Follow the terms of the notice that is currently in effect. Who Will Follow Our Practices: The practices described in this notice apply to the following person or groups of persons: All hospital personnel and student in training in all departments and units of the hospital and at all hospital locations. Any health care professional authorized to enter information or obtain information from your hospital record. Any volunteer or member of a volunteer group that assists you while you are in the hospital. Medical Staff members, attending physicians, radiologists, pathologists, anesthesiologists, surgeons, internal medicine physicians, emergency department physicians who work at the hospital whether as employees or members of an organized health care arrangement. The hospital, and those listed above, may share information with each other for treatment, payment or health care operations as described in this notice. How We May Use and Disclose Your Health Information Treatment: We will use your health information for treatment. For example: Information gathered by a nurse, doctor, or other member of your treatment team will be entered into your record and used to determine your course of treatment. They will also record their assessment of your response to treatment.

2 Page 2 This information may also be shared with other parties involved in your care including consulting health care providers and other facilities to which you may be transferred. You health information may also be used to coordinate your care and to inform you of alternative treatments, providers or setting of care that are thought to be of potential benefit to you. Payment: We will use and disclose your health information to obtain payment for the services provided to you. For example, when you register for service, we will use your information to verify that you have insurance coverage. After you have received service, a bill that identifies you and contains your diagnosis and the procedures performed will be sent to your insurer or to you. We may also send your contact information to collection agencies if your payment is overdue. You have the right to request restrictions on PHI disclosures to your individual health plan for health services or items paid out-of-pocket in full and the covered entity must comply with such request. Psychotherapy Notes: Most uses and disclosures of psychotherapy notes (if recorded by the hospital) will require the individual s authorization. Health Care Operations: We will use and disclose your health information for health care operations. For example, we may use your health information to review the skills of our health care professionals, to conduct training or education programs, and to perform quality reviews of appointment reminder. We may also share your contact information with hospital administration so they are aware of the presence of persons in our hospital. Your health information may be disclosed to students who observe treatment and other hospital procedures during supervised programs within our facility. Fundraising: Lawrence County Memorial Hospital chooses not to disclose information to the Endowment and Development Foundation for use in raising money for the hospital. Hospital Directory: Unless you object, we may include your name, location in the hospital, general condition (e.g., good, fair) and religious affiliation in a hospital directory. If anyone asks for you by name, we will give them the information you have agreed for inclusion in the directory, except for your religious affiliation. If members of the clergy request, we will give them your directory information. You may request restriction on the content of your hospital directory listing by notifying the Admissions Clerk. Notification: We may use information we ve gathered about you to notify your family, personal representative or others involved in your care about your location in our facility and your general condition. Communication with Family: Unless you object, we may discuss your health care with members of your family, close friends or other individuals you identify who may be involved in your care or the payment for your care. In addition, we may disclose medical information about you to our entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.

3 Page 3 Research: We may disclose information about you to researchers whose research has been approved by an institutional review board. The review board will establish protocols to appropriately protect the privacy of your information. As Required By Law: We will use or disclose health information about you when required to do so by federal, state, or local law. To Avert a Serious Threat to Health or Safety: When necessary, we may use and disclose your health information to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any discloser, however, would be only to those to whom the threat is relevant. Organ and Tissue Donation: If you are an organ donor, we may use or disclose your health information to organizations that handle organ procurement, organ, eye or tissue transplantation, or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation. Military and Veterans: If you are a member of the armed forces, we may disclose your health information as required by military command authorities. National Security and Intelligence Activities: We may release medical information about you to authorized federal officials for intelligence, counterintelligence and other national security activities authorized by law. Protective Services for the President and Others: We may disclose medical information about you to authorized federal officials so they may provide protection to the President, and other authorized persons of foreign heads of state to conduct special investigations. Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution. Worker s Compensation: If you are receiving treatment under Worker s Compensation, we will disclose your health information related to a work-related illness or injury to your employer, case manager, other health care providers and workers comp insurers as permitted by state law. Public Health Activities: We may disclose your health information to public health authorities for public health activities such as: To report certain diseases, disabilities or injuries that are authorized to be reported to local, state, or federal health agencies. To report births and deaths to the appropriate state registries. To report child or adult abuse or neglect to the appropriate authorities.

4 Page 4 To report reactions to medications to problems with medical products to the FDA. To notify people of recalls of products they may be using. To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition. Health Oversight Activities: We may use or disclose your health information to a health oversight agency for audits, investigations, inspections, licensure and other monitoring activities authorized by law. Legal Disputes: We may disclose your health information in response to a court or administrative order or other court preceding that compels release of the information. Law Enforcement: We may release your health information to local, state, or federal law enforcement officials when required by law. We may release limited patient information to local, state or federal law enforcement officials for identification or location purposes, national or state security, or to notify them of known of suspected criminal conduct. We may disclose protected health information about an individual whom we reasonably believe to be a victim of abuse, neglect or domestic violence to a government authority, including a social service or protective services agency, authorized by law to receive reports of such abuse neglect or domestic violence. Coroners, Medical Examiners and Funeral Directors: we may use or disclose health information to a coroner or medical examiner as required by law. We may also release limited health information about deceased patients of the hospital to funeral directors as necessary to carry out their duties. Your Rights Regarding Health Information About You Right to Inspect and Copy: You have the right to inspect and obtain a copy of the information we maintain on you in your medical records, billing records and other records used to make decisions about your care. To inspect and obtain a copy of this health information, you must submit your request in writing to our Medical Records Department. Please note that we charge a fee for the costs of copying, mailing or supplies associated with your request. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to your health information for certain reasons, you may request that the denial be reviewed. Another licensed health care professional chosen by the hospital will review your request and the denial. The person conducting the review will not be the one of the persons involved in the initial denial. We will comply with the determination made by the review.

5 Page 5 Right to Amend Information: If you believe that the health information we have about you is incorrect or incomplete, you may request that we amend the information. You have the right to request an amendment for as long as we keep your information. Your request for amendment must be in writing and sent to our Medical Records Department. You must include a reason that supports your request for amendment. We may deny your request for an amendment if it does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that: Was not created by us, unless the person or entity that created the information is no longer available to the make the amendment. Is not part of the health information kept by or for the hospital. Is not part of the information that you would be permitted to inspect and copy. Is accurate and complete. Right to an Accounting of Disclosures: We are required to keep an account of certain disclosures we make of your health information and you are entitled to a copy of that account. To request a list of such disclosures, you must submit your request in writing to our Medical Records Department. Your request must state the time period for which you want the list of disclosures, but the time period cannot be any longer than the preceding six years and may not include dates before April 14, The first list you request within a 12-month period will be free. However, if you request additional lists during this period, we will charge you for the costs of providing the list. Right to Request Restrictions: You have the right to request a restriction on how we use or disclose the health information we use for the purposes of treatment, payment, or health care operations. You also have the right to request a limit on your health information that we disclose to someone who is involved in your care or the payment for your care, such as a family member or friend. To request restrictions to our use or disclosure of your health information, you must make your request in writing to the Medical Records Department. We cannot restrict disclosures made of your directory information to particular individuals except if you opt out of inclusion in the directory. We cannot accept restriction on information whose release is required by law. We cannot restrict disclosures made prior to your request for restriction. The restrictions you request will not apply to disclosures made directly to you. We are not required to agree to your request for restrictions nor provide a reason for our denial. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment or if we later inform you that we have reversed our decision.

6 Page 6 Right to Request Alternative Delivery of Information: You have the right to request that we communicate with you about health matters via alternative means or at alternative locations. For example, you may request that we only telephone you at work or that we mail your records to you at a location other than your home. To request alternative delivery of information, you must make your request in writing to the Medical Records Department. Your request must specify how or where you wish to be contacted. We will accommodate requests that we can reasonably meet. Right to a Paper Copy of Notice: You may obtain a paper copy of the Notice of Privacy Practices from the Admitting Office at the hospital. Changes to This Notice We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in the hospital. The notice will contain on the first page, in the top right hand corner, the effective date of the notice. Complaints: If you believe your privacy rights have been violated, you may file a complaint with the hospital or with the Secretary of the Department of Health and Human Services. To file a complaint with the hospital, contact the Privacy Officer at Lawrence County Memorial Hospital or write to the Privacy Officer at the following address: 2200 West State Street, Lawrenceville, Illinois All complaints must be submitted in writing. You will not be penalized for filing a complaint. Other Uses of Health Information Other uses and disclosures of health information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose your health information, you may, in most cases, revoke that permission, in writing, at any time. Please understand that we are unable to take back any disclosures that were previously made with your permission, and that we are required to retain our records of the care that we provided to you.

7 LAWRENCE COUNTY MEMORIAL HOSPITAL Lawrenceville, Illinois ACKNOWLEDGEMENT OF RECEIPT OF PRIVACY NOTICE By signing this form, you acknowledge that Lawrence County Memorial Hospital has given you a copy of its Privacy Notice, which explains how your health information will be handled in various situations. We must try to have you sign this form on your first date of service with us after April 14, If you first date of service with us was due to an emergency, we must try to give you this notice and get your signature acknowledging receipt of this notice as soon as we can after the emergency. Check all that are true: I have received Lawrence County Memorial Hospital s Privacy Notice. Lawrence County Memorial Hospital has given me chance to discuss my concerns and questions about the privacy of my health information. Date: Patient s Signature or Person Acting on Patient s Behalf Print Name Lawrence County Memorial Hospital Admitting staff should complete if Acknowledgement Form is not signed: 1. Does patient have a copy of the Privacy Notice? Yes No 2. Patient s Name: 3. Please explain why the patient was unable to sign an acknowledgement from and Lawrence County Memorial Hospital s efforts in trying to obtain the patient s signature: [ ] Lab work delivered by courier. Patient not present to receive Privacy Notice. Staff Signature: Place on Inside Cover of Medical Record

HIPAA Notice of Privacy Practices Effective Date: 09/23/13

HIPAA Notice of Privacy Practices Effective Date: 09/23/13 HIPAA Notice of Privacy Practices Effective Date: 09/23/13 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW

More information

Information with a person who is involved in your medical care or payment for your care, such as your family or a

Information with a person who is involved in your medical care or payment for your care, such as your family or a Notice of Privacy Practices Effective Date: September 23, 2013 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW

More information

HIPAA Notice of Privacy Practices

HIPAA Notice of Privacy Practices HIPAA Notice of Privacy Practices Date of Last Revision: 09/20/2013 Effective Date: Immediately THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS

More information

Notice of Privacy Practices

Notice of Privacy Practices Notice of Privacy Practices Pueblo Radiology Medical Group, Inc. Pueblo Radiology Associates, Inc. Central Coast Radiology Associates, Inc. Santa Barbara Women s Imaging Center Effective Date: September

More information

If you are under 18 years of age, your parents or guardian must sign for you and handle your privacy rights for you.

If you are under 18 years of age, your parents or guardian must sign for you and handle your privacy rights for you. HIPAA NOTICE OF PATIENT PRIVACY PRACTICES CWCC618 Exhibit A Effective Date: November 1, 2011 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS

More information

Notice of Privacy Practices

Notice of Privacy Practices Notice of Privacy Practices THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. About this notice

More information

MULTICARE ASSOCIATES OF THE TWIN CITIES, P.A. NOTICE OF PRIVACY PRACTICES

MULTICARE ASSOCIATES OF THE TWIN CITIES, P.A. NOTICE OF PRIVACY PRACTICES MULTICARE ASSOCIATES OF THE TWIN CITIES, P.A. NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

More information

BRAIN PERFORMANCE & PSYCHOLOGY CENTER NOTICE OF PRIVACY PRACTICES

BRAIN PERFORMANCE & PSYCHOLOGY CENTER NOTICE OF PRIVACY PRACTICES BRAIN PERFORMANCE & PSYCHOLOGY CENTER NOTICE OF PRIVACY PRACTICES Effective Date: 10-20-2014 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS

More information

HIPAA NOTICE OF PRIVACY PRACTICES

HIPAA NOTICE OF PRIVACY PRACTICES HIPAA NOTICE OF PRIVACY PRACTICES Marden Rehabilitation Associates, Inc. Marden Rehabilitation Associates of Ohio, Inc. Marden Rehabilitation Associates of West Virginia Health Care Plus Preferred Care

More information

Community Health of South Florida, Inc. 10300 SW 216 th Street Miami, FL 33190. Notice of Privacy Practices

Community Health of South Florida, Inc. 10300 SW 216 th Street Miami, FL 33190. Notice of Privacy Practices Community Health of South Florida, Inc. 10300 SW 216 th Street Miami, FL 33190 Effective Date: April 2003 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN

More information

OUR LADY OF THE LAKE, HOSPITAL INC. AND OUR LADY OF THE LAKE PHYSICIAN GROUP, LLC NOTICE OF PRIVACY PRACTICES

OUR LADY OF THE LAKE, HOSPITAL INC. AND OUR LADY OF THE LAKE PHYSICIAN GROUP, LLC NOTICE OF PRIVACY PRACTICES OUR LADY OF THE LAKE, HOSPITAL INC. AND OUR LADY OF THE LAKE PHYSICIAN GROUP, LLC NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU

More information

NOTICE OF PRIVACY PRACTICES

NOTICE OF PRIVACY PRACTICES NOTICE OF PRIVACY PRACTICES Effective Date: Immediately This information is made available to all patients THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU

More information

NOTICE OF PRIVACY PRACTICES

NOTICE OF PRIVACY PRACTICES NOTICE OF PRIVACY PRACTICES In 1996, the U.S. Congress passed the Health Insurance Portability and Accountability Act (HIPAA). Among others, the Act applies to health care providers and hospitals; it is

More information

NOTICE OF PRIVACY PRACTICES ILLINOIS EYE CENTER

NOTICE OF PRIVACY PRACTICES ILLINOIS EYE CENTER NOTICE OF PRIVACY PRACTICES ILLINOIS EYE CENTER THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED OR DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

More information

IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE OR IF YOU NEED MORE INFORMATION, PLEASE CONTACT OUR PRIVACY OFFICER:

IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE OR IF YOU NEED MORE INFORMATION, PLEASE CONTACT OUR PRIVACY OFFICER: NOTICE OF PRIVACY PRACTICES COMPLETE EYE CARE THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED OR DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

More information

Effective Date of This Notice: September 1, 2013

Effective Date of This Notice: September 1, 2013 Rev.10-2013-KB P-drive-HR Forms NOTICE OF HEALTH INFORMATION PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED OR DISCLOSED BY United Cerebral Palsy of Miami (UCP) and

More information

Policy & Procedure AUTUMN RIDGE RESIDENTIAL CARE. March, 2013

Policy & Procedure AUTUMN RIDGE RESIDENTIAL CARE. March, 2013 AUTUMN RIDGE RESIDENTIAL CARE Policy & Procedure HIPAA / PRIVACY NOTICE OF PRIVACY PRACTICES FUNCTION NUMBER PRIOR ISSUE EFFECTIVE DATE March, 2013 PURPOSE To ensure that a Notice of Privacy Practices

More information

WASHINGTON HOSPITAL HEALTHCARE SYSTEM (WHHS) NOTICE OF PRIVACY PRACTICES

WASHINGTON HOSPITAL HEALTHCARE SYSTEM (WHHS) NOTICE OF PRIVACY PRACTICES WASHINGTON HOSPITAL HEALTHCARE SYSTEM (WHHS) NOTICE OF PRIVACY PRACTICES Effective Date 8-1-2013 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS

More information

Wyoming School Boards Association Insurance Trust ( The Plan ) HEALTH CARE PLAN PRIVACY NOTICE

Wyoming School Boards Association Insurance Trust ( The Plan ) HEALTH CARE PLAN PRIVACY NOTICE Wyoming School Boards Association Insurance Trust ( The Plan ) HEALTH CARE PLAN PRIVACY NOTICE THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS

More information

HIPAA Notice of Patient Privacy Practices

HIPAA Notice of Patient Privacy Practices HIPAA Notice of Patient Privacy Practices Effective Date: January 1, 2014 THIS NOTICE DESCRIBES HOW PROTECTED HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

More information

Eye Clinic of Bellevue, LTD. P.S. Privacy Policy EYE CLINIC OF BELLEVUE LTD PS NOTICE OF INFORMATION PRACTICES

Eye Clinic of Bellevue, LTD. P.S. Privacy Policy EYE CLINIC OF BELLEVUE LTD PS NOTICE OF INFORMATION PRACTICES Eye Clinic of Bellevue, LTD. P.S. Privacy Policy EYE CLINIC OF BELLEVUE LTD PS NOTICE OF INFORMATION PRACTICES Date of Last Revision: 4/8/03 Effective Date: Immediately This information is made available

More information

University HealthCare Alliance

University HealthCare Alliance NOTICE OF PRIVACY PRACTICES University HealthCare Alliance Effective Date: September 23, 2013 THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED. PLEASE REVIEW IT CAREFULLY.

More information

Notice of Privacy Practices

Notice of Privacy Practices Notice of Privacy Practices THIS NOTICE OF PRIVACY PRACTICES DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

More information

NOTICE OF PRIVACY PRACTICE

NOTICE OF PRIVACY PRACTICE Effective Date: September 23, 2013 NOTICE OF PRIVACY PRACTICE UNIVERSITY OF CALIFORNIA SAN FRANCISCO UCSF HEALTH SYSTEM THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED

More information

This Notice describes Hill-Rom s practices regarding the use of your Protected Health Information, specifically including:

This Notice describes Hill-Rom s practices regarding the use of your Protected Health Information, specifically including: Original Effective Date: April 1, 2003 Effective Date of Last Revision: July 15, 2013 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS

More information

Notice of Privacy Practices

Notice of Privacy Practices Notice of Privacy Practices (Effective date: May 1, 2008) This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review

More information

NOTICE OF PRIVACY PRACTICES FOR OUR PATIENTS POTOMAC PHYSICIAN ASSOCIATES, P.C.

NOTICE OF PRIVACY PRACTICES FOR OUR PATIENTS POTOMAC PHYSICIAN ASSOCIATES, P.C. NOTICE OF PRIVACY PRACTICES FOR OUR PATIENTS POTOMAC PHYSICIAN ASSOCIATES, P.C. THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED OR DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

More information

NOTICE OF PRIVACY PRACTICES

NOTICE OF PRIVACY PRACTICES NOTICE OF PRIVACY PRACTICES This notice describes how your medical information may be used and disclosed, and how you can get access to this information. Chaparral House is required to provide you this

More information

Effective Date: September 23, 2013

Effective Date: September 23, 2013 Shawnee Mission Medical Center HIPAA NOTICE OF PRIVACY PRACTICES Effective Date: September 23, 2013 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET

More information

NOTICE OF PRIVACY PRACTICES FOR KU MEDICAL CENTER

NOTICE OF PRIVACY PRACTICES FOR KU MEDICAL CENTER Page 1 of 7 NOTICE OF PRIVACY PRACTICES FOR KU MEDICAL CENTER THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW

More information

NOTICE OF PRIVACY PRACTICE UCLA COUNSELING AND PSYCHOLOGICAL SERVICES (CAPS)

NOTICE OF PRIVACY PRACTICE UCLA COUNSELING AND PSYCHOLOGICAL SERVICES (CAPS) Effective Date: September 23, 2013 NOTICE OF PRIVACY PRACTICE UCLA COUNSELING AND PSYCHOLOGICAL SERVICES (CAPS) THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW

More information

Welcome To Our Physical Therapy Department

Welcome To Our Physical Therapy Department Welcome To Our Physical Therapy Department Our entire staff is dedicated to providing our patients with the best possible care and service while keeping the costs to you from increasing at an unreasonable

More information

HIPAA PRIVACY NOTICE PLEASE REVIEW IT CAREFULLY

HIPAA PRIVACY NOTICE PLEASE REVIEW IT CAREFULLY HIPAA PRIVACY NOTICE THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. INTRODUCTION PLEASE REVIEW IT CAREFULLY Moriarty

More information

If you have any questions about this notice, please contact Mimi McNichol 215-985-4448 ext. 223.

If you have any questions about this notice, please contact Mimi McNichol 215-985-4448 ext. 223. Philadelphia FIGHT NOTICE OF PRIVACY PRACTICES. Effective Date: April 14, 2003 Last Revised: May 2014 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET

More information

NOTICE OF HEALTH INFORMATION PRACTICES

NOTICE OF HEALTH INFORMATION PRACTICES NOTICE OF HEALTH INFORMATION PRACTICES Effective Date: April 14, 2003 Date Amended: 9/5/13 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO

More information

As Required by the Privacy Regulations Created as a Result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)

As Required by the Privacy Regulations Created as a Result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Craig Ranch OB/GYN NOTICE OF PRIVACY PRACTICES As Required by the Privacy Regulations Created as a Result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) THIS NOTICE DESCRIBES

More information

Notice of Privacy Practices

Notice of Privacy Practices Notice of Privacy Practices Effective September 20, 2013 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW

More information

SOUTHLAKE DERMATOLOGY 1170 N. Carroll Ave. Southlake, TX 76092 www.southlakedermatology.com Main 817-251-6500 Fax 817-442-0550

SOUTHLAKE DERMATOLOGY 1170 N. Carroll Ave. Southlake, TX 76092 www.southlakedermatology.com Main 817-251-6500 Fax 817-442-0550 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. EFFECTIVE September 15, 2014 This Notice of

More information

Harris County - Texas HIPAA Notice of Privacy Practices

Harris County - Texas HIPAA Notice of Privacy Practices Harris County - Texas HIPAA Notice of Privacy Practices Effective Date: September 23, 2013. THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS

More information

UAB MY HEALTH REWARDS BIOMETRIC SCREENING PROGRAM NOTICE OF HEALTH INFORMATION PRACTICES

UAB MY HEALTH REWARDS BIOMETRIC SCREENING PROGRAM NOTICE OF HEALTH INFORMATION PRACTICES UAB MY HEALTH REWARDS BIOMETRIC SCREENING PROGRAM NOTICE OF HEALTH INFORMATION PRACTICES 1 Effective Date: January 26, 2015 THIS NOTICE APPLIES TO THE UAB MY HEALTH REWARDS BIOMETRIC SCREENING PROGRAM

More information

Notice of Privacy Practices for Protected Health Information

Notice of Privacy Practices for Protected Health Information Notice of Privacy Practices for Protected Health Information This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review

More information

HIPAA NOTICE OF PRIVACY PRACTICES UNIVERSITY OF COLORADO HEALTH AND WELFARE PLAN NOTICE OF PRIVACY PRACTICES

HIPAA NOTICE OF PRIVACY PRACTICES UNIVERSITY OF COLORADO HEALTH AND WELFARE PLAN NOTICE OF PRIVACY PRACTICES HIPAA NOTICE OF PRIVACY PRACTICES UNIVERSITY OF COLORADO HEALTH AND WELFARE PLAN NOTICE OF PRIVACY PRACTICES THIS NOTICE OF PRIVACY PRACTICES DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND

More information

NOTICE OF PRIVACY PRACTICES

NOTICE OF PRIVACY PRACTICES Page 1 of 6 NOTICE OF PRIVACY PRACTICES Revised: June 15, 2014 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW

More information

Sarasota Personal Medicine 1250 S. Tamiami Trail, Suite 202 Sarasota, FL 34239 Phone 941.954.9990 Fax 941.954.9995

Sarasota Personal Medicine 1250 S. Tamiami Trail, Suite 202 Sarasota, FL 34239 Phone 941.954.9990 Fax 941.954.9995 Sarasota Personal Medicine 1250 S. Tamiami Trail, Suite 202 Sarasota, FL 34239 Phone 941.954.9990 Fax 941.954.9995 NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY

More information

Notice of Privacy Practices for Protected Health Information (PHI)

Notice of Privacy Practices for Protected Health Information (PHI) Notice of Privacy Practices for Protected Health Information (PHI) Arapahoe Sports Medicine and Rehabilitation THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW

More information

NOTICE OF PRIVACY PRACTICES

NOTICE OF PRIVACY PRACTICES Effective Date: September 23, 2013 THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. OUR PLEDGE

More information

Northwest Cardiology Associates 400 W. Northwest Hwy Barrington, IL 60010 847.382.4600 Fax 847.382.1771. HIPAA Notice of Privacy Practices ( Notice )

Northwest Cardiology Associates 400 W. Northwest Hwy Barrington, IL 60010 847.382.4600 Fax 847.382.1771. HIPAA Notice of Privacy Practices ( Notice ) Northwest Cardiology Associates 400 W. Northwest Hwy Barrington, IL 60010 847.382.4600 Fax 847.382.1771 HIPAA Notice of Privacy Practices ( Notice ) THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY

More information

Polk Medical Center Notice of Privacy Practices

Polk Medical Center Notice of Privacy Practices Polk Medical Center Notice of Privacy Practices THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

More information

650 Clark Way Palo Alto, CA 94304 650.326.5530

650 Clark Way Palo Alto, CA 94304 650.326.5530 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. (Adopted 4-14-03; revised December 2006) If

More information

APPLETREE PEDIATRICS, PA NOTICE OF PRIVACY PRACTICES

APPLETREE PEDIATRICS, PA NOTICE OF PRIVACY PRACTICES APPLETREE PEDIATRICS, PA NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

More information

NOTICE OF PRIVACY PRACTICES Allergy Treatment Center of New Jersey, P.C. Effective Date: April 14, 2003

NOTICE OF PRIVACY PRACTICES Allergy Treatment Center of New Jersey, P.C. Effective Date: April 14, 2003 Allergy Treatment Center of New Jersey, P.C. 388 Pompton Avenue 415 Avenel Street Cedar Grove, NJ 07009 Avenel, NJ 07001 (973) 857 9890 (732) 636-7030 NOTICE OF PRIVACY PRACTICES Allergy Treatment Center

More information

NORTHSTAR DERMATOLOGY, PA NOTICE OF PRIVACY PRACTICES

NORTHSTAR DERMATOLOGY, PA NOTICE OF PRIVACY PRACTICES NORTHSTAR DERMATOLOGY, PA NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT

More information

GONZABA MEDICAL GROUP PATIENT REGISTRATION FORM

GONZABA MEDICAL GROUP PATIENT REGISTRATION FORM GONZABA MEDICAL GROUP PATIENT REGISTRATION FORM DATE: CHART#: GUARANTOR INFORMATION LAST NAME: FIRST NAME: MI: ADDRESS: HOME PHONE: ADDRESS: CITY/STATE: ZIP CODE: **************************************************************************************

More information

NOTICE OF PSYCHOLOGIST S POLICIES AND PRACTICES TO PROTECT THE PRIVACY OF YOUR HEALTH INFORMATION

NOTICE OF PSYCHOLOGIST S POLICIES AND PRACTICES TO PROTECT THE PRIVACY OF YOUR HEALTH INFORMATION Effective Date: 09/23/2013 Paul Beljan, PsyD, ABPdN, ABN Alison E.F. Reuter, PhD, ABPdN Laura Wingers, PsyD Kate Bree, PsyD Vanessa Berens, PhD Jacob Boney, PsyD, BCBA-D 9835 E. Bell Rd., Ste. 140 Scottsdale,

More information

NOTICE OF PRIVACY PRACTICES

NOTICE OF PRIVACY PRACTICES NOTICE OF PRIVACY PRACTICES Integrated Rehabilitation Group & LLC Affiliates Effective Date: April 14, 2003 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU

More information

MERCY HEALTH MEDICAL TRANSPORTATION SERVICES PRIVACY NOTICE Revised Notice Effective Date: September 23, 2013

MERCY HEALTH MEDICAL TRANSPORTATION SERVICES PRIVACY NOTICE Revised Notice Effective Date: September 23, 2013 MERCY HEALTH MEDICAL TRANSPORTATION SERVICES PRIVACY NOTICE Revised Notice Effective Date: September 23, 2013 THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU

More information

Floyd Healthcare Management, Inc. Notice of Privacy Practices

Floyd Healthcare Management, Inc. Notice of Privacy Practices Floyd Healthcare Management, Inc. Notice of Privacy Practices THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW

More information

NOTICE OF PRIVACY PRACTICES

NOTICE OF PRIVACY PRACTICES NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. IF YOU HAVE ANY

More information

Notice of Privacy Practices. Human Resources Division Employees Benefits Section

Notice of Privacy Practices. Human Resources Division Employees Benefits Section Notice of Privacy Practices Human Resources Division Employees Benefits Section THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

More information

APOSTOLIC CHRISTIAN HOME OF EUREKA NOTICE OF PRIVACY PRACTICES

APOSTOLIC CHRISTIAN HOME OF EUREKA NOTICE OF PRIVACY PRACTICES APOSTOLIC CHRISTIAN HOME OF EUREKA NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW

More information

UNITED CEREBRAL PALSY OF NORTHWEST MISSOURI NOTICE OF PRIVACY PRACTICES EFFECTIVE DATE: OCTOBER 22, 2014

UNITED CEREBRAL PALSY OF NORTHWEST MISSOURI NOTICE OF PRIVACY PRACTICES EFFECTIVE DATE: OCTOBER 22, 2014 UNITED CEREBRAL PALSY OF NORTHWEST MISSOURI NOTICE OF PRIVACY PRACTICES EFFECTIVE DATE: OCTOBER 22, 2014 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN

More information

Borinquen Health Care Center 3601 Federal Highway Miami, FL (305)

Borinquen Health Care Center 3601 Federal Highway Miami, FL (305) Borinquen Health Care Center 3601 Federal Highway Miami, FL 33137 (305) 576-6611 NOTICE OF PRIVACY PRACTICES Effective Date: July 1, 2014 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE

More information

FLORIDA MEDICAL CLINIC, P.A. NOTICE OF PRIVACY PRACTICES

FLORIDA MEDICAL CLINIC, P.A. NOTICE OF PRIVACY PRACTICES FLORIDA MEDICAL CLINIC, P.A. NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW

More information

MILITARY HEALTH SYSTEM NOTICE OF PRIVACY PRACTICES. Effective April 14, 2003

MILITARY HEALTH SYSTEM NOTICE OF PRIVACY PRACTICES. Effective April 14, 2003 HEALTH AFFAIRS MILITARY HEALTH SYSTEM NOTICE OF PRIVACY PRACTICES Effective April 14, 2003 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO

More information

DALLAS ALLERGY & ASTHMA CENTER

DALLAS ALLERGY & ASTHMA CENTER DALLAS ALLERGY & ASTHMA CENTER Gary N. Gross, MD Michael E. Ruff, MD 5499 Glen Lakes Dr., Suite 100 Dallas, TX 75231 Dania A. Wierzbicki, MD Phone: (214) 691-1330 Jane Zepeda, PA-C FAX: (214) 691-6405

More information

NOTICE OF HEALTH INFORMATION PRIVACY PRACTICES (HIPAA)

NOTICE OF HEALTH INFORMATION PRIVACY PRACTICES (HIPAA) NOTICE OF HEALTH INFORMATION PRIVACY PRACTICES (HIPAA) THIS NOTICE OF PRIVACY PRACTICES DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

More information

National Home Health Care HIPAA Notice of Privacy Practices

National Home Health Care HIPAA Notice of Privacy Practices Effective Date: THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. If you have any questions about

More information

ADVANCED INTEGRATIVE REHABILITATION AND PAIN CENTER David P. Sniezek, DC, MD, MBA, FAAIM NOTICE OF PRIVACY PRACTICES

ADVANCED INTEGRATIVE REHABILITATION AND PAIN CENTER David P. Sniezek, DC, MD, MBA, FAAIM NOTICE OF PRIVACY PRACTICES ADVANCED INTEGRATIVE REHABILITATION AND PAIN CENTER David P. Sniezek, DC, MD, MBA, FAAIM NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND

More information

Salt Lake Community College Employee Health Care Benefits Plan Notice of Privacy Practices

Salt Lake Community College Employee Health Care Benefits Plan Notice of Privacy Practices THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. Date: June 1, 2014 Salt Lake Community College

More information

Psychological Services & Holistic Health, Inc.

Psychological Services & Holistic Health, Inc. Psychological Services & Holistic Health, Inc. 626 Wilshire Boulevard, Suite 910 3990 Westerly Place, Suite 160 Los Angeles, CA 90017 Newport Beach, CA 92660 Phone: (213) 622-0633 Fax: (213) 622-5633 NOTICE

More information

Dr. Adam Apfelblat 5140 Highland Road Waterford 48327 Phone: (248)618-3467 Fax: (248)618-3515

Dr. Adam Apfelblat 5140 Highland Road Waterford 48327 Phone: (248)618-3467 Fax: (248)618-3515 Dr. Adam Apfelblat 5140 Highland Road Waterford 48327 HIPAA NOTICE OF PRIVACY PRACTICES PLEASE REVIEW THIS NOTICE CAREFULLY. IT DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW

More information

Guilford Medical Associates, P.A.

Guilford Medical Associates, P.A. Page 1 Guilford Medical Associates, P.A. NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE

More information

SOUTH CAROLINA PUBLIC EMPLOYEE BENEFIT AUTHORITY (PEBA) NOTICE OF PRIVACY PRACTICES

SOUTH CAROLINA PUBLIC EMPLOYEE BENEFIT AUTHORITY (PEBA) NOTICE OF PRIVACY PRACTICES SOUTH CAROLINA PUBLIC EMPLOYEE BENEFIT AUTHORITY (PEBA) NOTICE OF PRIVACY PRACTICES Effective April 14, 2003 Revised September 23, 2013 This notice describes how medical information about you may be used

More information

HIPAA NOTICE OF PRIVACY PRACTICES

HIPAA NOTICE OF PRIVACY PRACTICES HIPAA NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. This HIPAA Notice

More information

Accredited Home Health Care of America - Notice of Privacy Practices

Accredited Home Health Care of America - Notice of Privacy Practices Accredited Home Health Care of America - Notice of Privacy Practices THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE

More information

Pulmonary Associates of Richmond, Inc. Notice of Privacy Practices Page 1 of 6

Pulmonary Associates of Richmond, Inc. Notice of Privacy Practices Page 1 of 6 Page 1 of 6 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. If you have any questions about

More information

The College of William and Mary Division of Sports Medicine. Notice of Privacy Practices

The College of William and Mary Division of Sports Medicine. Notice of Privacy Practices Notice of Privacy Practices This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. If you have any

More information

Privacy Notice Document (HIPAA)

Privacy Notice Document (HIPAA) Privacy Notice Document (HIPAA) THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. This Privacy

More information

Patterson Dental Supply, Inc. Sample HIPAA Notice of Privacy Practices for its Dental Practice Customers. Last Updated April 1, 2010

Patterson Dental Supply, Inc. Sample HIPAA Notice of Privacy Practices for its Dental Practice Customers. Last Updated April 1, 2010 Patterson Dental Supply, Inc. Sample HIPAA Notice of Privacy Practices for its Dental Practice Customers Last Updated April 1, 2010 This sample HIPAA Notice of Privacy Practices is being provided by Patterson

More information

Notice of Privacy Practices Walter L Cohen High School School-based Health Center. Effective as of August 6, 2004

Notice of Privacy Practices Walter L Cohen High School School-based Health Center. Effective as of August 6, 2004 Effective as of August 6, 2004 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. We are required

More information

Resthave Home of Whiteside County, Illinois Resthave Nursing Home Resthave Home Assisted Living. Notice of Privacy Practices

Resthave Home of Whiteside County, Illinois Resthave Nursing Home Resthave Home Assisted Living. Notice of Privacy Practices Resthave Home of Whiteside County, Illinois Resthave Nursing Home Resthave Home Assisted Living Notice of Privacy Practices THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED

More information

Reproductive Medicine Associates of New Jersey, LLC

Reproductive Medicine Associates of New Jersey, LLC NOTICE OF PRIVACY PRACTICES Effective Date: September 20, 2013 Last Modified: May 12, 2013 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO

More information

NOTICE OF PRIVACY PRACTICES DILEY RIDGE MEDICAL CENTER

NOTICE OF PRIVACY PRACTICES DILEY RIDGE MEDICAL CENTER NOTICE OF PRIVACY PRACTICES DILEY RIDGE MEDICAL CENTER Effective Date: 3/1/2010 Version: 30110.1 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS

More information

DETAILED NOTICE OF PRIVACY AND SECURITY PRACTICES OF THE Trustees of the Stevens Institute of Technology Health & Welfare Plan

DETAILED NOTICE OF PRIVACY AND SECURITY PRACTICES OF THE Trustees of the Stevens Institute of Technology Health & Welfare Plan DETAILED NOTICE OF PRIVACY AND SECURITY PRACTICES OF THE Trustees of the Stevens Institute of Technology Health & Welfare Plan THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED

More information

NOTICE OF PRIVACY PRACTICES TEMPLATE. Sections highlighted in yellow are optional sections, depending on if applicable

NOTICE OF PRIVACY PRACTICES TEMPLATE. Sections highlighted in yellow are optional sections, depending on if applicable NOTICE OF PRIVACY PRACTICES TEMPLATE Sections highlighted in yellow are optional sections, depending on if applicable Original Date: ##/##/#### Revised per HIPAA Omnibus Rule ##/##/#### Revised Date Implementation:

More information

NOTICE OF PRIVACY PRACTICES

NOTICE OF PRIVACY PRACTICES BERG-FEINFIELD VISION CORRECTION Alan M. Berg, M.D. Inc. - Robert E. Feinfield, M.D., Inc. Barbara S. Yates, M.D Mireille P.Hamparian, MD. Talia Kolin, M.D. Nelson R. Bates, O.D. Carol S. Felestian, O.D.

More information

NOTICE OF HIPAA PRIVACY AND SECURITY PRACTICES

NOTICE OF HIPAA PRIVACY AND SECURITY PRACTICES SCHOOL DISTRICT OF BLACK RIVER FALLS 523.5 Exhibit NOTICE OF HIPAA PRIVACY AND SECURITY PRACTICES PRIVACY NOTICE This notice describes how medical information about you may be used and disclosed and how

More information

Notice of Privacy Practices

Notice of Privacy Practices Kimmel Chaplain Pharmacy NCPDP: 1413018 205 Bailey Lane Benton, IL 62812 Notice of Privacy Practices THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET

More information

Patti Levin, LICSW, Psy.D. Clinical Psychologist

Patti Levin, LICSW, Psy.D. Clinical Psychologist Patti Levin, LICSW, Psy.D. Clinical Psychologist 673 Boylston St. #4. 617.227.2008 Boston, MA02116 fax: 617.247.7523 www.drpattilevin.com email:patti@drpattilevin.com Notice of Privacy Practices (HIPAA)

More information

HIPAA NOTICE OF PRIVACY PRACTICES Woodlands Behavioral Healthcare Network (WBHN)

HIPAA NOTICE OF PRIVACY PRACTICES Woodlands Behavioral Healthcare Network (WBHN) HIPAA NOTICE OF PRIVACY PRACTICES Woodlands Behavioral Healthcare Network (WBHN) Effective Date: 04/14/15 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN

More information

NOTICE OF PRIVACY PRACTICES

NOTICE OF PRIVACY PRACTICES NOTICE OF PRIVACY PRACTICES The Pain Treatment Center, Inc. d/b/a Stone Road Surgery Center THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS

More information

HOW WE MAY USE AND DISCLOSE MEDICALINFORMATION ABOUT YOU:

HOW WE MAY USE AND DISCLOSE MEDICALINFORMATION ABOUT YOU: INDIANA UNIVERSITY NORTHWEST CAMPUS HEALTH AND WELLNESS CENTER 3400 Broadway Gary, Indiana 46408-1197 (219) 980-7250 NOTICE OF PRIVACY PRACTICES Effective Date: SEPTEMBER 2008 THIS NOTICE DESCRIBES HOW

More information

HIPAA Privacy Notice

HIPAA Privacy Notice HIPAA Privacy Notice This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. This notice describes

More information

HIPAA HITECH PA Physician Practices

HIPAA HITECH PA Physician Practices NOTICE OF PRIVACY PRACTICES Premier Urology Associates LLC dba Urology Care Alliance SUMMARY Effective Date: 12/20/2012 WHAT IS THIS NOTICE FOR? This Notice of Privacy Practices (Notice) describes how

More information

Atlanta Insomnia & Behavioral Health Services, P.C. 315 West Ponce de Leon Ave Suite 1051 Decatur, GA 30030 404-378-0441

Atlanta Insomnia & Behavioral Health Services, P.C. 315 West Ponce de Leon Ave Suite 1051 Decatur, GA 30030 404-378-0441 Atlanta Insomnia & Behavioral Health Services, P.C. 315 West Ponce de Leon Ave Suite 1051 Decatur, GA 30030 404-378-0441 Health Insurance Portability and Accountability Act (HIPAA) NOTICE OF PRIVACY PRACTICES

More information

Effective April 14, 2003

Effective April 14, 2003 Effective April 14, 2003 THE BOEING COMPANY GROUP HEALTH PLANS NOTICE OF PRIVACY PRACTICES This notice describes how health plan medical information about you may be used and disclosed and how you can

More information

Richmond Gastroenterology Associates, Inc.

Richmond Gastroenterology Associates, Inc. Richmond Gastroenterology Associates, Inc. Notice of Privacy Practices THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFOMRATION.

More information

Notice of Privacy Practices

Notice of Privacy Practices Notice of Privacy Practices This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. This practice uses

More information

HIPAA Notice of Privacy Practices HAND & MICROSURGERY ASSOCIATES, INC.

HIPAA Notice of Privacy Practices HAND & MICROSURGERY ASSOCIATES, INC. HIPAA Notice of Privacy Practices HAND & MICROSURGERY ASSOCIATES, INC. THIS NOTICE OF PRIVACY PRACTICES (THE NOTICE ) DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN

More information

HIPAA POLICIES & PROCEDURES AND ADMINISTRATIVE FORMS TABLE OF CONTENTS

HIPAA POLICIES & PROCEDURES AND ADMINISTRATIVE FORMS TABLE OF CONTENTS HIPAA POLICIES & PROCEDURES AND ADMINISTRATIVE FORMS TABLE OF CONTENTS 1. HIPAA Privacy Policies & Procedures Overview (Policy & Procedure) 2. HIPAA Privacy Officer (Policy & Procedure) 3. Notice of Privacy

More information